From the papers reported in the recent two years or two terms of the major conferences -International, American and Japanese-, the major topics are PDT, plastic surgery, low power laser and cardiovascular fiels.
In the research on PDT, the palliative therapy on the advanced cancers and the radical therapy on the early cancers were tried and the new photosensitizer which are more effective, more selective and less complications were studied.
In the research on low power laser application, the major topics are tissue welding, pain relief, wound healing, irradiation effect on cells and laser diagnosis.
In the cardio vascular fields, the major topics is coronary angioplasty utilizing HO-YAG and excimer laser.
In the USA, Canada, and Europe, the results of the complihensive clinical cases were reported. The procedure successful rates are 80-90% and laser indication will be for, ostial region and longer case without calcification and torture lesions.

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Forty six cases of glottis carcinomas treated with CO₂ laser or KTP/532 laser were reviewed. The 5-year determinate survival rate was 100%. The voice conservation rate was 96% for T1a and 80% for T1b. Vocal function was satisfactorily preserved for daily life. The results led to the following conclusion: 1) lesions involving anterior commissure can be treated by laser excision and vaporization. 2) Glottic T1 carcinomas can be treated by laser surgery alone.

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Lasermedicine is applied widely in various fields of medicine, not only for therapeutic but also for diagnostic medicine today. Laser has its high energy effects to human tissue essentially. Irradiation of laser power to human body has its effects for beneficial use, while it has also side effects for human being. These side effects are mainly divided into two categories, the one is eye the other is skin.
Safety standard or guideline are inevitable for the safe use of laser. Various standards and guide lines have been issued by several organizations from beginning of 1970s. ANSI standards, IEC standards are famous for the assurance of safety in usual use of lasers. JIS safety-standards are applicable in JAPAN. On the other hand, safety standard for medical use of lasers has not been issued until recently in the world. JAPAN has preceded in this field,for publications of safety guidelines for medical use of lasers. Safety guide line for medical use of laser has published in 1988 by the joint committee of “Japanese Society for Laser Medicine” and “Medical Instrument Society Japan”. Now its improvement is in progress by the same committee.
Also sufficient education for medical personell is quite important for the safety assurance of medical application of lasers.

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A remarkable advancement has recently achieved in the field of photonics and optical electronics to develop high sensitivity technology for quantitative measurement and analysis of extremely weak optical signals such as not detectable by the human eye. Over the past decades or so, we have been engaged in research and development of super-high sensitivity technology of detecting and processing ultraweak photonic information characterized by extremely low level light containing merely a small number of photons.
In this invited paper, recent progress and trends in biophoton research, i. e., novel applications of this technology of photonic measurements are reviewed and summarized together with their new findings and results. Biophoton is a new concept representing ultraweak photon emission phenomenon closely related to life processes and biological activities, observable quite generally in nature. Hence this phenomenon is considered as a novel source of biological and vital information originating from a variety of microscopic and macroscopic living systems.

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Japan now appreciates the longest life expectancy in the world, which is mainly due to the advancement in the medical technology. It will become one of the most aging societies in the 21st century as a result of rapid increase in the ratio of the elderly population.
At present, the most important issue we are facing is improvement of living conditions where everyone can enjoy a healthy and comfortable life.
Therefore, we should stress on R & D activities on medical devices.
In July 1992. an interim report to the director-general of Pharmaceutical Affairs Bureau, Ministry of Health and Welfare, on medical device policy was announced.
The report says that, medical device policy must respond to the following social needs;
1) Development of supplemental physical function to supporting tissue such as eyes and ears that deteriorate as people become older.
2) Development of small and easy-to-use medical device and system.
Following are action programs for development of such medical devices:
1) Install data bank and information exchange opportunities among parties concerned.
2) Set development goal for private companies.
3) Incremental budget to fundamental technology development and R & D projects.
4) Registration of implant patients and after care system.
5) Development of distribution infrastructure including maintenance system.

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The Laser is called the most important and also the best invention of this century, generally quantum effects appear in the microscopic state, but the laser phenomena itself set in the macroscopic way to response to the human sense. It has very wide applications in the high technology fields such as material processing, various measurements, photo chemistry laser fusion and bio-medical applications. The 21st century will be a bright light age for human beings.

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We developed new laser angioplasty system, which employed the angioscopic guidance and total system conceptions. In order to attain a large volume ablation for the plaque with a sufficient safety margin, the manipulatable angioscope was newly developed to achieve precise targeting to the atheromatous lesion as well as observation/diagnosis at pre-, during, and post- laser therapy. The whole catheter rotation and tight bending at the catheter tip gave complete tip controllability to the catheter. The thin CO laser cable was also developed. This 600um diameter cable was the first practical laser cable which used the infrared glass fiber.
The medical CO laser device was newly developed. This apparatus was the first medical CO laser, which had fail-safe mechanism and transportable design. The system controller could manage these components to keep safety during the laser therapy. This new angioscope system was developed under the contract of the National Research and Development Programs of Medical and Welfare Apparatus from the Ministry of International Trade and Industry, Japan.

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To investigate the detail features of the coronary arterial lesions, we observed them using the technique of percutaneous transluminal coronary angioscopy. We studied 129 patients with ischemic heart disease during routine coronary catheterization, and 29 of them were studied before and after PTCA. In the stenotic or obstructive lesions, two types of plaque, regular plaque and complex, were noted. The latter, with various kinds of intimal injury and / or thrombus, was common with unstable angina and acute myocardial infarction. Whereas, the former, without intimal change, was common with stable angina. After PTCA, most target lesions were revealed to be associated with various degree of intimal injury and thrombus, which were rarely detected by routine coronary angiography. As regard to regular plaque, the lesions with yellow plaque were dilated more smoothly than the lesions with white plaque.
Coronary angioscopy is a useful method for investigating and comparing the coronary lesions, and will be able to play an important role as a guiding and estimating method for the other diagnostic measures or interventional therapies.

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Percutaneous transluminal laser angioplasty (PTLA) has been carried out on 90 lesions of peripheral arterial occlusive disease in 61 patients.
The number of lesions and degree of stenosis are as follows: 5 lesions (equal to or less than 50%), 3 lesions(over 50% and equal to or less than 80%), 54 lesions (over 80%, including complete occlusion).
There are 52 lesions that are equal to or less than 2cm in length, 24 lesions that are more than 2cm and equal to or less than 10cm, 14 lesions that are over 10cm.
A 1.06μm continuous wave Nd: YAG laser was used for the ablation and vaporization of atheromatous plaque and thrombus. The laser was irradiated by increments of 1 to 2 seconds at 80W using the noncontact method, at 10-25W using the contact method with a ceramic tip and at 10-15W with a bare laser fiber. Balloon dilatation was added.
The initial success rate was 90%. The 6-year cumulative patency rate after PTLA is 89.7% in the total lesions, 91.4% in the iliac lesions, 85.8% in the femoropopliteal lesions and 100% in the tibial or peroneal lesions.
PTLA seems to have improved the cumulative patency rate when compared with that of conventional PTA. PTLA enable to recanalized occluded arteries, even if the conventional PTA failed.
Distal embolization occured in 5 cases, but it could be avoided after we started to utilize aspiration of sludge materials with a 7 to 8F catheter.
No perforation of the artery by laser was encountered.

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Lasers have been recently utilized in the field of cardiovascular surgery through the world.
Most of them are fundamental works concerning laser angioplasty.
Since 1980 we have started three scientific studies as follows. That is, 1) myocardial revascularization by laser, 2) vascular anastomosis, 3) laser angioplasty.
On the basis of excellent experimental studies in these fields. lasers were clinically applied with safety.
The numbers of the patients for whom lasers were utilized reached to 185 cases.
They consisted of one case with myocardial revascularization, 110 cases with laser vascular anastomosis including coronary artery bypass grafting of 13 cases and 74 cases with laser angioplasty including intraoperative coronary angioplasty of 10 cases.
Twenty-four cases of them received laser applications, because of angina pectoris and myocardial infarction.
Characteristics of lasers were clearly recognized even in our clinical experience. Indications, techniques and long-term results of laser applications in cardiovascular surgery were reported in detail.

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We investigated the time course of hematoporphyrin oligomer uptake in squamous cell carcinoma transplanted into C3H mice after intraperitoneal injection by measuring its fluorescence intensity. The intensity peaked 83 hours after the injection. The tumors disappeared after an average of 4.40 days with a single application of photodynamic therapy or microwave hyperthermia 83 hours after hematoporphyrin oligomer injection. However, all the tumors treated with these single modalities regrew within 4 weeks after the treatments. Therefore, we investigated the therapeutic effect of microwave hyperthermia in combination with photodynamic therapy. As a result, the combination effect was strongest when high-dose therapy was used as the first choice, irrespective of the order of the treatments, and no tumor regrowth occurred for 45 days.
Moreover, we applied above-mentioned single and combined modalities to the same carcinoma 48 hours after PH-I126 intravenous injection. The same tendency was observed in the combined condition. However, the antitumor effects were stronger in the single modalities than in the combined modalities, although the tumor regrowth occured after its disappearance.

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Laserthermia is a localized hyperthermia using Nd: YAG laser. We applied laserthermia to 10 cases with oral and oropharyngeal cancers (tongue: 7, oral floor: 2, tonsil: 1). All cases were combined with 50 Gy irradiation. The results showed that laserthermia was effective for T2 and T3 cases, however not for T4 cases. Laserthermia demonstrated the possibility to control less than T3 tumor without operation and to demand the preservation of oral function.

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The method of endonasal surgery has been improved by using an endoscope and a Video system (CCD - camera, TV monitor etc.). The KTP/532 laser is a surgical laser whose delivery system with noncontact and contact flexible fibers allows its use with the nasal endoscopes for intranasal surgery. The KTP/532 laser was applied in endoscopic endonasal surgery for chronic sinusitis, postoperative maxillary cyst, hypertrophic turbinate.
The patient sat in a supine posture, and the operation was performed under local anesthesia. This operation could be completed without giving any pain to the patient by radiation within 5 seconds with a laser output 10-14 watts. The intranasal and intrasinus lesions were vaporized, coagulated, and cut with excellent hemostasis by the KTP/532 laser. The postoperative courses were satisfactory.

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Endolaryngeal CO₂ laser surgery has been performed for 169 patients with early glottic carcinoma during from 1978 to 1991 in our clinic. 7 were Tis, 81 were T1 a, 41 were T1 b and 40 were T2. 59 were treated only with laser surgery and 104 were received a combined radiotherapy after laser surgery. Other 6 were treated with laser surgery for recurrence after radiotherapy. 5-year survival rate without intercurrent diseases was 97% for all cases. Local control rate was calculated by actuarial method. 5-year control rate was 58% for Tis, 76% for T1 b and 13% for T1 b in cases of laser surgery alone. In laser combined with radiation cases, that rate was 88% for T1 a, 77% for T1 b and 92% for T2. For laser cases for radiation failure, the local control became 0%until fourth year. In 36 out of 37 cases of local recurrence, the recurrent carcinoma was well controlled by laser surgery, radiotherapy, hemilaryngectomy and total laryngectomy. Other one case refused the therapy. Those results suggest that T1 a is a candidate for laser surgery and that laser surgery for T1 b and T2 should be combined with radiotherapy.

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In four years from July 1988 to July 1992, surgical operation was performed in 261 patients, 306 cases at the laser outpatient clinic of the department of otolaryngology, National Defense Medical College. They are broken down to nasal disease 215 cases, oral cavity disease 68 cases, laryngo-tracheal disease 12 cases, pharyngeal disease 5 cases and 6 other cases. All the patients developed no such serious complications as requiring hospital admission, and laser operation was performed safely at outpatient clinic.
It can be mentioned as the merit of laser surgery that hemorrhage during and after operation is very slight. With this surgery, intranasal tampon and special nasal treatment in rhinological surgery and suturing of the operative wound and extraction of stitches in oral surgery are no longer needed, which will make easy surgery at the outpatient clinic and expand the indications of such surgery.

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From October 1986 to October 1992, Six patients were evaluated for ureteroscopic treatment in combination with Nd: YAG laser treatment of upper urinary tract tumors. Tow patients had benign ureteral polyps. 4 patients had transitional cell carcinoma. Two Patients with polyp were only treated ureteroscopycaly. 4 carcinoma patients were treated 5 times by laser. One patient had local recurrence and 1 patient had high grade bladder tumors and multiple ureter tumor. Finally both of these patients were treated by nephroureterectomy. Of 5 patients with ureteral tumors who were believed to be candidates for endoscopic therapy, 4 were controlled by this method of treatment. In selected individuals ureteroscopic laser treatment of upper urinary tract transitional cell carcinoma can achieve local control with renal preservation.

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Because the pulsed dye laser can be transmitted through a thin, flexible quartz fiber, a small caliber ureteroscope and flexible ureteroscope are applicable. And damage to normal ureter by laser irradiation is so minimal. 188 cases (197 renoureteral unit) were treated using pulsed dye laser. Complete fragmentation was achieved 53 of 67 renal stones and 114 of 130 ureteral stones at 1st session. There was no complication requiring surgical correction.
TUL using pulsed dye laser is safe and highly successful for not only ureteral but renal calculi.

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Between June 1991 and October 1992, we carried out ureterolithotripsy using pulse-dye laser on 157 patients with 159 ureteral calculi. In 63 cases (39.6%), calculi were pushed up during this procedure, and were disintegrated using ESWL. In 142 cases (89.3%), calculi were disintegrated completely into fragments less than 1mm in diameter in a single session. Operating time ranged between 12 and 120 minutes with median of 38. One patient underwent ureterolithotomy due to stricture of the ureteral orifice. And one patient underwent nephrectomy due to pyonephrosis found during lithotripsy. Ureteral injury was noted in 12 cases (7.5%). Eleven patients (6.9%) showed fever rise more than 38.5°C. However, serious complications were not observed. The patients were hospitalized after operation for median of 4 days. Thus, laser lithotripsy was effective method for managing ureteral calculi, especially located in the lower and juxtavesical ureter.

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In order to ablate fibrous scar tissue with little thermal damage, we evaluated a ultraviolet argon laser(UV Ar) and holmium-YAG laser(Ho:YAG) as the therapeutic lasers for the urinary tract strictures. These lasers were able to be delivered by a novel multi-fiber catheter which has 21 pixels of SiO₂ glass fiber with a guide wire channel.
The canine isolated ureter was ablated by both lasers in different power and time. The ratio of thermal damage area to ablated hole was approximately 40% by UV Ar and 30% by Ho:YAG. The canine ureter and urethra were then ablated in vivo by both lasers via the multi-fiber catheter. The ureter were ablated circumferentially till the submucosal layer without perforation.
To evaluate long term results of laser plasty for ureteral stricture, the canine ureteral stricture created surgically by a Chitin tube was treated by a UV Ar with multi-fiber catheter. The ureteral patency without a ureteral stent was confirmed by the intravenous pyelography 11 weeks after the treatment. Histological study of the treated segment of the ureter showed no fibrosis. From these results, we concluded that the laser plasty with a UV Ar laser and a Ho:YAG laser could be a useful treatment modality for urinary tract stricture.

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We have had experience in the treatment of 3 patients with 7 strictures with new laser, KTP laser. This laser has a unique ability to cut and coagulate with minimal thermal damage, and minimal forward scatter to help prevent the formation of new scar tissue. All of the patients have had attempts of treatment of urethral strictures with direct vision cold knife urethrotomy unsuccessfully in the past. The laser was effective in 86% of strictures, although the number of patients was small and follow-up periods have been short at the time of this report ranging from 4 to 7 months. Under sacral block, all of the patients were able to be treated safely as an outpatient surgical procedure. This new laser may have some promise in the treatment of urethral stricture disease.

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The usefulness of photodynamic therapy (PDT) for experimental tumors by using Photofrin II and excimer dye laser was studied. High antitumor effects on Sarcoma 180 graft were obtained when PDT was performed 48 hours after iv administration of Photofrin II at a dose of 25mg/kg following the laser irradiation at energy of 50J/cm₂ (80Hz, 4mJ/pulse). Under the same condition, the nonspecific anticancer effects of PDT on murine Lewis lung carcinoma, human fibrosarcoma HT-1080, and human bladder transitional cell carcinoma kk-47 grafts were observed. These results suggest that clinical applications of PDT with Photofrin II and excimer dye laser might be useful.

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We investigated the usefulness of TULIP procedure to relieve bladder outlet obstruction due to BPH. TULIP system consists of an ultrasound imager and a transurethral probe that has an ultrasound transducer and a neodymium YAG laser window. With the use of a real-time ultrasound sector scan, laser energy can be applied precisely to the prostate.
TULIP was carried out under spinal or epidural anesthesia on 60 patients with BPH (age 73.4±7.7yrs [mean±S. D.], prostatic size 40.1±15.6gm). The average operation time, laser irradiation dose and estimated blood loss were 48.7±16.2min, 9480±3000Joules an 9.6±10.0ml, respectively. At 3 month after TULIP, the mean modified Boyarsky symptom score significantly improved from a pre-operative level of 22.4±5.4 to 7.5±5.5, (P<0.001). The post-treatment evaluation also showed a significant increase (P<0.001) in maximum flow rate from 6.2±4.1ml/sec to 12.0±5.4ml/sec and a remarkable decrease (P<0.005) in residual urine volume from 89±77ml to 21±38ml. No serious complications have occurred. All patients have been discharged within 5 days of hospitalization as expected. These results demonstrated that TULIP is a safe and useful alternative procedure for prostatic obstruction.

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In 1979, Birch et al. reported that the morphology of erythrocytes in hematuria differs under the phase contrast microscope between patients with nephritis and those with urological diseases. However, a simple and objective examination method based on this morphological difference in erythrocytes has not been established. The objective of this study was to evaluate the usefulness of the laser microscope for the diagnosis of microhematuria. Characteristics of the test were evaluated in 88 patients with hematuria. The sensitivity and the specificity of the examination to nephritis were 98.1% and 100%, retrospectively. This urinalysis was carried out in 66 of 86 patients who were positive for urinary occult blood among 987 patients who underwent health screening, and the nephritis type findings were obtained in 50%.
This laser microscopic urinalysis is considered to be a simple and objective examination method. It is useful, especially because it makes urological evaluation unnecessary in about half the patients positive for occult blood in urine.

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Objective: Angioscopy has proved to provide more detailed information on lesion morphology than angiography. Therefore, to evaluate the effects of vascular interventions, angioscopy was performed in 68 patients with peripheral or coronary artery disease who underwent interventions.
Methods and results: PTCA: Angioscopy was performed in 29 patients who underwent PTCA. The characteristics of angioscopic findings after PTCA consisted of cleft, fractures of plaques, intimal bleeding, exfoliation of endothelium and thin mural thrombi. Thermal laser anigoplasty: Angioscopy was performed 12 patients who underwent laser thermal angioplasty. Laser thermal angioplasty was performed with a Nd:YAG laser system equipped with a probe temperature programmable microprocessor that could monitor and control probe temperature simultaneously. Coagulation and carbonization were observed, when the probe temperature was over loot and 200°C, respectively. Excimer laser anigioplasty: Angioscopy was performed in 2 patients with peripheral and 25 patients with coronary artery disease who underwent excimer laser angioplasty. The excimer laser was operated at 308 nm, 135 nsec, 25 Hz and 40-60mJ/mm² and was coupled into multifiber wire-guided catheters. The characteristics of angioscopic findings after excimer laser angioplasty consisted of flaps, fractures of plaques and abundant tissue remnants. There was no apparent thermal injury.
Conclusions: These results indicate that 1) angioscopy is effective and safe for evaluation of lesion morphology after interventions, 2) excimer laser ablation does not result in thermal injury, which is commonly observed after thermal laser ablation, 3) irregular channels after recanalization and abundant tissue remnants may explain the suboptimal results after excimer laser angioplasty, and 4) all interventions may result in the same kind of mechanical vascular wall damage.

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The development of the medical endoscope keeps pace with the times, and the video endoscope which has a CCD chip combined on its distal end has been introduced in addition to the conventional fiberscope. Furthermore,development is now going on seeking an ultimate style of endoscope.
There is a“limit”to various unit of the endoscope. For example, length (outer diameter, total length), temperature, wavelength (electromagnetic waves to be observed) and tolerance for chemical etc. In diameter as a representative unit, 0.25-0.35 is already developed. Though it has been said that limit of fiber-diameter was 5μm, 2μm fiber is developed now by changing refractive index of adjoining core. It was attempted obtain a thermo-image inside body by infrared rays fiber (AsS) as image guide fiber and thermo-viewer. Resolution in temperature by ±0.5°C will enable us to obtain real time thermo-image vitro.
Video endoscope has a big possibility to do photosensitizer by the application filters. If the sensitivity of the CCD is improved, this is possible to be realized. Ultra slim endoscope with a micro actuator can possibly be introduced into a deeper part with less damage to an organ. Nowadays the basic studies are proceeding. The endoscope will incorporate an artificial intelligence. Then it aims to be a micro robot with a biopsy capability.

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In this Paper, I propose the feasibility of coherent imaging using lasers. This paper reviews several methods for realizing image formation through a highly scattering medium using coherent technique such as Coherent Detection Imaging (CDI), Optical Coherent Tomography (OCT) and Chrono-Coherent Imaging (CCI).
For the establishment of laser absorption computer-assisted tomography for biomedical applications on the basis of not only the projection slice theorem but also of image reconstruction by the optical diffusion tomography, the following four properties for optical detection should be satisfied basically; 1) Directionality, 2) Excellent sensitivity, 3) Wavelength selectivity and 4) Detectability of optical path distribution.

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We reported the outline of the record about the endoscopic treatment for early gastric cancers drafted by the Judgement Committee of Endoscopic Treatment for Early Gastric Cancers (Japan Gastroenterological Endoscopy Society).
This outline consists of the following items;
1.Purpose of this outline
2. Informed consent
3. Objects of the treatment
4. Description about characterization of the lesion
5. Description about the treatment
6. Evaluation of the treatment
7. Follow-up the lesion after the treatment
8. Endoscopic feature of the lesion with recurrence after the treatment
We would like to have any valuable opinion for this outline proposed by clinical colleagues after applying it clinically.

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Endoscopic mucosal resection (ER) and laser therapy are used against superficial esophageal cancer as endoscopic treatment. The ER is thought to be one of radical treatment for superficial esophageal cancer without lymph node or distant metastasis. But for the inoperable patients because of severe complications, ER is not only used, but also laser therapy is used. In this study, we examined about the effectiveness of laser therapy for superficial esophageal cancer and the way of follow-up after the therapy.
From 1982 to 1992 at National Cancer Center Hospital, 13 patients with 14 lesions of superficial esophageal cancer were treated by laser endoscopy. The mean age of these was 73.8 years (range 62-87) and all patients had no indication for surgical operation reasons for severe complications, malignancies of other organs and refusal of surgery. The sex ratio was 12 (male/female: 12/1). Macroscopically, 1 lesion was 0-I+IIc type, II lesions were 0-IIc type and 2 lesions were 0-IIc+IIb type. About the size, 3 lesions were less than 20mm, 8 lesions were 21-40mm, 2 lesions were 41-60mm and 1 lesion was more than 61mm. Two kinds of methods as laser therapy were performed; one was photodynamic therapy (PDT: hematoporphyrin derivative+argon-dye laser) and the other Nd: YAG laser using a balloon. This balloon method was the way using a latex balloon filled with distilled water to keep the good position for laser irradiation. Nd: YAG laser was irradiated through its balloon and distilled water. Six lesions were treated by PDT (polypectomy and/or radiation was added to 3 lesions) and 8 lesions by the balloon method (radiation was added to one lesion).
In 13 lesions out of 14, cancer cells disappeared after therapy. But the residue of cancer was revealed in one lesion that was wide 0-IIc+IIb type cancer (50mm in size) treated by PDT. In 4 out of 9 lesions followed up for more than a year after therapy, the recurrence of cancer was detected (PDT: 1 lesion, Nd: YAG laser: 3 lesions). These 4 recurrent lesions were found 6, 6, 7 and 12 months after treatment, respectively. These lesions were retreated by laser therapy and 3 lesions were free from cancer for more than 1 year. In one patient, the recurrence was detected again 27 months after 2nd laser therapy. And in another patient, new lesion with superficial esophageal cancer was detected by follow-up study and treated by laser endoscopic therapy. There was no lesion that progressed to the advanced cancer by follow-up and there were no patients who died of esophageal cancer expect for 6 patients died of the other diseases.
In summary, it was thought that frequent follow-up, especially for a year after laser therapy, and long follow-up by endoscopy should be performed for check-up of local recurrence or the new lesions.

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Eleven cases of oropharyngeal cancers (T2, T3) treated with laserthermia were reviewed. In six cases of oropharyngeal carcinomas, tumor cells were not found postoperatively. These tumors responded well to a combination of laserthermia and conventional treatment.
Thirty seven cases of laryngeal cancers(T1, T2) treated with CO₂ laser were also reviewed. The voice conservation rate for T2 was 52.5%in the traditional therapy, but its rate in a combination therapy of CO₂ laser and traditional treatment was 88.9%.

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Nd: YAG laser surgery has been applied endoscopically for the treatment of bladder tumor. However, there were some controversies whether laser could prevent the recurrence of the tumor. Herein, we showed the technical method, the clinical result and tumor recurrence in order to evaluate the efficacy of transurethral laser surgery (TULS). The evaluation of the complete treatment was depend upon image diagnosis, endoscopy, histology before and after the treatment, and clinical course. TULS was performed in 208 treatments with 144 bladder tumor patients. Clinical staging was classified as T_aT₁ in 131 and T₂ in 13. According to the clinical course, recurrence occurred in 48.9%of T_aT₁ and 76.9%of T₂. However, TULS was regarded as incomplete in cases with residual tumor endoscopically and the tumor recurrence within 3 months. As the results, TULS tended to be incomplete in multiple, large tumors and these located in dome. Therefore, the following conditions were judged as the complete laser treatment that (1) tumor showed completely necrotized by endoscopy, (2) tumor disappeared in the image diagnosis, (3) tumor did not show orthotopic recurrence within 3 months.

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Ten cases of Nd:YAG laser ablation and five cases of CO laser ablation on bullous diseases of lungs were studied, and roles and problems of laser surgery were discussed according to the appearance of the bullae with Oohata's classification.
Nd:YAG laser has suitable penetration depth to get the alveolar tissue through bullae and CO laser shows certain effects just on the wall of the bulla. In small bullae (type II and typeVI), satisfying coagulation shrinkage could be brought with any kind of laser, but in large bullae (type III), perforation occured in two cases of CO laser group and because of their large surface dimensions, inadequate shrinkage of bulla wall and thick coagulation of alveolar tissue with perforation were observed in two cases of Nd:YAG laser group. Each laser has advantages and disadvantages for any types of bulla.
The role of the laser surgery on the bullous diseases will be important in the near future.

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In Japan over 90 percent of primary liver cancers are associated with hepatitis or cirrhosis. Less invasive treatment is important in these cases. So a series of experimental and clinical studies on spherical laser coagulation therapy of liver tumor are being performed by our group. Shape of the fiber tip was made to get a uniform spherical discharge of laser beam. Through such tip it was possible to get a round coagulation. The optimal shape of the tip to get the uniform spherical discharge was analyzed and confirmed by a computed ray tracing method.
Heat conduction of such spherical coagulation as well as the cooling effect of the blood flow on the heat conduction were studied. The prior estimation of the size of the spherical coagulation with a calculated energy delivery was also achieved.
Three dimensional view of liver was reconstructed from the slices of CT and MRI and evaluated for approach to the tumors. Percutaneous transhepatic laser vaporization as well as laparoscopic laser ablation using laparoscopic 'Ojigi Ultrasonographic Probe' were developed.

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We have clinically applied the CO₂ laser knives and experienced 1677 cases from 1977 to October 31, 1992.
The CO₂ laser is a surgical technique which can resect preventing dissemination and metastasis against malignant disease because it is possible to rapidly shield lymph ducts and microvessels.
It is more available for skin surface or anal surgeries.
We would study the application for endoscopy and laparoscospy due to the fiber CO₂ laser.

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Recent advance in surgery owes not only to the development of operative techniques but also to the development of instruments which support surgical operations. Operative procuderes consist mainly of incision. hemostasis, and suture, but incision is the reverse procedure to hemostasis, and it has been a dream for surgeons to incise without bleeding. An electric knife, well known as Bobby, is an evolutional instrument which enables us simultaneous incision and coagulation. However, its ability for hemostasis is still limited. Resection of solid organs, especially the liver, sometimes involves much bleeding. Therefore the further development of new methods or instruments have been long-expected to realize safety incision without bleedings. Since the first success in transmission of laser beam was reported by Maiman in 1960, application of laser beam has been attempted in every fields. As a matter of course. introduction of it was tried immediately also in medicine. In surgery, laser beam has been investigated of its availability for a tissue dissector which involves no bleeding, coagulator, or diagnostic and therapeutic instruments. In this article, the history of laser beam during these 30 years and its future aspect will be discussed.

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Absorption spectra of Photofrin and mono-L-aspartyl chlorin e6 (NPe6) in phosphate buffered saline solution (PH7. 2) and pheophorbide derivative (P1-1126) in methanol have a characteristic Soret band at 370-400 nm. At the Q bands, Photofrin have four peaks at 506, 540, 570, 620 nm and NPe6 have the peaks at 502, 530, 620, 664 nm and PH-1126 have the peaks at 490, 500. 4, 596. 8, 652.4 nm. Those photosensitizer emitted a fluorescence with a excitation at each absorptonpeaks. The peak wavelength of fluorescent spectrum from NPe6 was a 670 nm in phosphate bufferedsaline solution (PB7. 2). Atherosclerosis were induced in the aorta and the coronary artery of rabbits with severe cholesteremia. NPe6 as a photosensitizer was administered intravenously into the ear vein of the rabbits at a dose of 5 mg/Kg bodyweight. At 6 hours after injection, the angioscope catheter was inserted into the aorta under sterile conditions. The 672 nm fluorescence of the NPe6 observed from a atherosclerotic lesion in the aorta at 405 nm excitation. Fluorescence of NPe6 on atherosclerotic lesion in coronaryartery were observed on the surface of the heart with a surgical micro fluorescence scope. The angioscope fluorescence analyzer system and surgical micro fluorescence scope demonstrated the possibility of future applications for diagnosis of atherosclerotic lesion using photosensitizers.

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In order to develop the tumor localizing fluorescent diagnostic agents without phototoxity, various compounds combined by some spacers between a protoporphyrin derivative and its Mn- and Cu-derivatives were synthesized. A typical fluorescent diagnostic agent without phototoxity was named as HAT-D01 and has a molecular structure of

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We have synthesized new photosensitizers. Comparing the Pheophorbide derivatives and Hematoporphyrin derivative (HpD) intermes of the longest absorption peak of Q band, the wavelength of the Pheophorbide derivatives is 35nm longer. In terms of the absorption rate at the longest absorption peak of Q band with pheophorbide derivatives and HpD on same concentration showed the absorption of 10 value. Therefore, Photodynamic effects using Pheoporbide derivatives would probably be greater than those of HpD, because of the distance of absorption band from that at hemoglobin. Comparing the accumulation in transplanted mice tumor tissues of pheoporbide derivatives at 24 and 48 hours after i. v. administration, PH-1126 was shown higher accumulation than other peoporbide derivatives. PH-1126 was given intravenously at a dose of 10mg/kg, and the site of the transplanted tumor was treated by laser irradiation (Kr+ laser) at energy doses of 60 to 100J/cm² with a power density of 40, 90 and 100mW/cm² at 48 hours after administration. Tumor tissues decreased at 2 to 4 days after PDT in tumor bering mice treated with a power density of more than 90mW/cm² and the total energy of more than 60J/cm². The tumor mass was further decreased with time. Further, the regrowth of tumor mass was not recognized during the experimental period (100days).

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New chlorins and their dimers for PDT photosensitizer, various oxime or bishydrazonecoupled porphyrins, have been synthesized from protoporphyrin dimethyl ester (PP-Me) in 3-4 steps. At first, the photooxidation of PP-Me is carried out to obtain a formylchlorin (photoprotoporphyrin dimethyl ester, P-Me). The derivative is treated with various ketone agents, for example, hydroxylamine, hydrazone and so on. The resulting porphyrins have structures of Fig. 1. Their agents were tested by means of UV spectra (>650nm), dansyl methionine method (photooxidation)(>650nm),and albumin binding method (cancer affinity). The efficacy of the new agents were preeminent. Therefore, the new chlorin and their dimers seem to be more useful for tumor diagnosis and treatment.

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This paper reports the results of photodynamic therapy (PDT) for patients with superficial esophageal cancer (SEC) and early gastric cancer (EGC) using polyhematoporphyrin ether/ester (PHE, freeze-dried Photofrin 11) and an excimer dye laser (EDL) which has extremely high peak power at 400 kW [4]. Then, we postulate the characteristics of an ideal photosensitizer in the future. From September 1990 until March 1992, we treated 6 patients with SEC and 17 patients with EGC by PDT with PHE and EDL. These patients could not be treated by operation because of high risk factors or old age. In all cases a histological diagnosis of carcinoma was possible by biopsy, and the depth of cancer invasion was assessed by endoscopic findings. The methods are as follows: 2 mg/kg of PHE was injected intravenously, and then, about 50 hours later, the entire lesion plus a 5 mm width of marginal mucosa was irradiated with the EDL beam transmitted endoscopically. The irradiation was delivered at a total dose more than 60 J/04 [3]. The response was evaluated by endoscopy with biopsy in the follow-up examinations, and was classified into two grades according to curability, cure or no cure [1]. Of these 6 patients with SEC, which consist of 3 mucosal and 3 submucosal squamous cell carcinomas, and 17 patients with EGC, which consist of 12 mucosal and 5 submucosal adenocarcinomas, 5 SEC and 16 EGC were cured by initial PDT, The final rate of cure was 100% (7/7) in SEC and 100% (17/17) in EGC, as being shown in figure 1 and 2, respectively. The characteristics of an ideal photosensitizer in the future can be summarized as follows: 1. a pure chemical compound; 2. no acute and chronic toxicity; 3. affinity to the cytoplasm of malignant cells; 4. no retention in normal tissue; 5. absorption peak at around 700 nm wavelength; 6. effective for every kind of cancer; 7. photodynamic effect proportionates to strength of fluorescence; 8. can be neutralized with some medicine; and 9. similar distribution in human and animals.

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We used the Nd:YAG laser for treatment of endometriosis (136cases), peritubal adhesions (62cases), perifimblial adhesions (7cases) and hydrosalpinx (24cases) patients. Endometriosis patients complained of infertility (108cases) and dysmenorrhea (28cases).
The laparoscopic procedures so far undertaken in our clinic include: Coagulation of peritoneal endometriosis, aspiration of chocolate cyst, removal of ovarian endometriosis, uterine nerve ablation, fimbrioplasty, adhesiolysis, salpingostomy and irrigation.
After undergoing this procedure, 52 of 108 patients of endometriosis(48%) achieved pregnancy and 26 of 28 dysmenorrhea patients obtained pain relief.
Thirteen of 36 patients of peritubal adhesion(36.1%), 2 of 7 patients of perifimblial adhesion(28.6%), and 4 of 24 patients of hydrosalpinx(16.7%) achieved pregnancy.
We confirmed that laparoscopic laser surgery is an effective treatment for infertility and dysmenorrhea patients.

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Laser excisional conization was performed on 310 cases with cervical neoplasia (glandular dysplasia; 2, dysplasia; 181, CIS; 68, questionable micro invasive cancer; 56, micro invasive cancer; 2, questionable invasive cancer; 1) by using various lasers such as YAG, CO₂ and KTP/YAG lasers. Two hundreds and eighty eight of 310 patients were operated with an administration of local anesthesia at an outpatient basis. Our initial cure rates of 289 patients (CIN; 255, MIC; 33, micro invasive adeno cancer; 1)were 96.9%. On the other hand, there was no evidence of recurrence in 21 patients who received the additional surgery. The complications during and post operations were minimal. Our methods were confirmed to be an excellent treatment for cervical neoplasia.

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There are argon, krypton, dye, diode and Nd: YAG lasers commercially available for laser photocoagulation of the posterior segment. This is particularly important for treatment of the xanthophyll laden area of the macula. For the treatment of macular lesions, argon laser is not recommended. Because argon laser is absorbed at the level of the pigment epithelium and xanthophyll.
When leakage is focal and central vision is threatened by foveal edema in diabetic maculopathy, dye and krypton laser photocoagulation will usually dry out the involved area and prevent further visual loss. To clear edema from the fovea in retinal vein occlusion, dye and krypton laser photocoagulation will be placed to the macula. This is extending peripherally with scattered laser treatment. The patients with visual decrease from disciform macular degeneration may benefit from dye, diode and Nd:YAG laser treatment if a subretinal new vessel is demonstrated to be outside the vessel free zone. If central serous retinopathy does not subside in 3 months, dye and krypton laser photocoagulation may be considered to the site of retinal pigment epithelium leakage.

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Selective damage of dilated dermal vessels on portwine stains induced by 585nm pulsed dye laser at pulse duration of 450μs (Candela model SPTL-1), and of melanosomes on nevus spilus induced by 510nm pulsed dye laser at pulse duration of 375ns (Candela model PLDL-1) were examined light and electron microscopically.
selective photothermolysis was made on portwine stains with minimal scar formation in the dermis and no disorder of epidermal pigmentation. On nevus spilus, melanosomal disruption was accompanied by necrosis of epidermis, and after reepithelization the epidermis showed normal pigmentation except a few cases with hyperpigmentation as nevus spilus.

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We have followed-up 443 portwine stains (PWS) for 6months to 12years after argon laser therapy and dye laser therapy. 253 PWS were treted with argon laser and 190 were done with dye laser.
The results were excellent in 11.3%, good in 52.4%, fair in 36.3% in argon laser sense and in dye series were excellent in 15.8%, good in 55.8%, fair in 28.4%. Scar formation were remarkably slight with dye laser treatment in comparision with argon laser.
From this study dye laser treatment is more easy and an effective method than argon laser treatment.

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For the treatment of Hemangioma simplex, we are using two different kinds of dye laser, SPTL-1 (Candela) and Do101 (NIIC). Although both tease laser apparatuses are effective, we recognized slight difference in therapeutic result with their repeated treatment.
First, using colored papers, comparative experiment was carried out to verify the difference in the property on the color between these two apparatuses. The experiment consisted in irradiations in varied output by putting one isochromatic paper (pink, red, purple, light brown) upon another. As a result, SPTL-1 and Do101 showed somewhat high decolorizing effects on pink-light red and purple and light brown, respectively. Similar tendency was observed not only regarding the difference in clinical therapeutic effect by macroscopic judgement, but also regarding the objective judgement of therapeutic effects using colorimeter (Minolta CR-200). On the other hand, in pathological examination (Hematoxylin-eosin stain), SPTL-1 was superior in tissue selectivity and penetrability and Do101 showed somewhat strong non-selective effect on the perivascular tissue. The above results suggested a somewhat different therapeutic effects between SPTL-1 and Do101.

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Although flashlamp pumped dye laser has become the first choice for treating portwine stains, its effectiveness is considered to have its own limitation. A new theory is advocated in which you can understand the histopathological reaction and prognostic diagnosis.
Each kind of portwine stain vessels reacts as follows; In case of relatively less energy, coagulated blood dissolute again and the abnormal vessels remain intact (re-canalization). In case of enough energy, some large vessels suffer thermal damage and change to small neo-vessels (re-vascularization) or small vessels turn to be granulation tissue (banishment).
A new histological classification of portwine stain is advocated in which a clinical type is expressed by a combination of three vessel types; subepidermal, papillary and reticular vessels. On magnificate inspection, subepidermal vessels look granular, papillary vessels look arborescence, and reticular vessels look even redness. This theory enables easy analysis for the structure of the portwine stain vessels, and furthermore, easy estimation of the prognosis after flashlamp dye laser exposure.

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Since June 1989 the anthers utilized the Pulse Wave Laser on 566 patients mainly with Hemangioma simplex. The patients were divided into three groups according to the gross appearance, microscopic findings, and the location of the lesions. Group 1 included dark red to pale violet hemangiomas showing dilated capillaries in the dermal papillae microscopically. Group 3 included pale red to pink hemangiomas with proliferation of normal-size capillaries in the dermal papillae. Group 2 included those lesions intermediate between group 1 and 3. The hemangiomas of head, neck and trunk were treated with success. The best results were obtained from group 1, followed by group 2. The results from group 3 were variable. The hemangiomas of the extremities were almost successfully treated, except for those in group 3.
Hemangiomas not responsive to laser treatment were found in the lower dermis. In contrast, responsive ones were found in the upper-middle dermis. However, repeated applications proved more effective, especially in the deeper lesions.
Dye Laser can also be applied to Capillary telangiectasia, Cavernous hemangioma, and Strawberry mark and abnormal pigmentations like Nevus Spilus.

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Since Jun 1988,the author have been treated about 700 cases of portwine stains with dye laser radiation (Candela SPTL-1). 209 of these cases whose treatment had terminated at least 6 months previously were placed under observation and follow up. Satisfactory results were achieved in about 70%,and less satisfactory results were in about 30%. all cases were treated without scarring and pigmentation. dye laser radiation for PWS still have some problems clinically in follows I) poor results cases (about 30%). 2) no commercialized topical anesthetics. 3) high cost.

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Now, I have been utilizing the commercial units, Candela model SPTL-1 (wavelength 585nm, pulse duration 450 microsec.) and NIIC model DO-101 (wavelength 590nm, pulse duration 300 microsec.).
I treat the patients with portwine stain, telangiectasia, vascular spider and pigmented lesion with Flashlamp dye laser.
When I treated there lesions, I try to measure to energy density by same power meter. Two type pulsed dye laser irradiated to the same test site with same energy density. A follow-up period after test treatment of 6 months. The average dose for treatment was 6.0 J/cm² (range 5.5 to 6.5 J/cm²).
No scar formation was observed in the 6 months after irradiation by both dye laser but the secondary pigmentation was appeared by SPTL-1. The more favorable site resulted in the use of the SPTL-1 for the portwine stain, telangiectasia and vascular spider. The DO-101 has been shown to of results on the portwine steins and pigmented lesions.

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The medical CO laser has been expected to be the most useful therapy laser because of its excellent ablation capability for atheromatous lesions and fiber delivery capability by means of the chalcogenide glass fiber. We developed the transportable medical CO laser system with user-friendly and fail-safe design for the therapy. The typical wavelength of the CO laser is 5.4μm and its maximum output laser power is 10 watts. The laser power emitted at the end of the laser cable can be controlled at the desired value of between 1 to 3 watts. The dimensions of the system are 140cm in height, 65cm in width, and 75cm in depth. It is compact enough to be accepted on the actual clinical scene. The transportability of the system was well examined.
In vivo animal experiment showed good results (good response yield: 6/7=86%). As another application of the medical CO laser, a thoracospic treatment for spontaneous pneumothorax can be expected. Some of the preliminary clinical experiences showed good results (success yield: 6/8=75%).

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